NALTREXONE the facts about for Treatment of Opioid Addiction

the facts about
NALTREXONE
for Treatment of Opioid Addiction
“It’s not like I woke up one day when I was
young and told myself, ‘I wanna be a drug
addict. I wanna ruin my life and ruin the
lives of those around me.’ I’ve learned now
that this is a disease, and when I pick up
that first drug, I can’t stop.”
Dan P.
How do you return from the ruin of drug addiction? Most
people cannot do it alone. They need help to return to normal,
healthy living. One important form of help is called medicationassisted treatment.
There are three, equally important parts to this form of
treatment:
• Medication
• Counseling
• Support from family and friends.
Naltrexone is one type of medication used for treatment
of opioid addiction. Perhaps your doctor or substance abuse
treatment provider has recommended it for you, or perhaps
you already take it. This booklet gives you the facts you need
to know.
NOTE: Important words often used in treatment are
introduced in this booklet in bold type.
ii
Opioid addiction is a disease.
Opioids are drugs that slow down the actions of the body, such as
breathing and heartbeat. Opioids also affect the brain to increase
pleasant feelings. They get their name from opium, a drug made
from the poppy plant.
Opioid medications are prescribed to treat pain and sometimes
for other health problems such as severe coughing. Heroin is an
illegal opioid that is smoked, snorted, or injected to get a good
feeling, often called a “rush” or “high.” People also sometimes
seek this feeling by taking large doses of prescription opioids.
If you take opioids, you can become tolerant to them. This
means that more of the drug is needed to obtain its effects. It
is also possible to become dependent on opioids. This means
that if you stop taking them, you will feel sick. This sickness is
called withdrawal. Dependence is not the same as addiction,
but sometimes dependence leads to addiction. The signs of
addiction are:
• Craving—The mind develops an overwhelming desire for
the drug.
• Loss of control—It becomes harder to say no to using the
drug. Use is compulsive and continues even though the drug
causes harm.
Tolerance and dependence are common side effects of
prescribed opioid medication that can be managed under a
doctor’s care. Tolerance and dependence also are side effects
from misuse of opioids. Addiction is not likely to develop in a
person using medication properly, but this sometimes happens.
Addiction usually occurs through misuse. Some people are at
higher risk of addiction because of their genes, temperament,
or personal situation.
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Not everyone who uses opioids gets addicted. But it is difficult to
stop using opioids after you have become addicted, because the
cravings are so strong and the fear of withdrawal is so great.
Opioid addiction can be treated.
Opioid addiction is a chronic disease, like heart disease or
diabetes. A chronic disease is a medical condition for life. It
cannot be cured, but it can be managed. A person with addiction
can regain a healthy, productive life.
But if you are like most people, you cannot walk away from
addiction on your own. Treatment—the care of medical
professionals and substance abuse treatment providers—can help.
Treatment helps you give up the problem drug. It helps you get
through withdrawal and cope with cravings. Treatment also
helps you change addictive thinking into nonaddictive, healthful patterns. It can help you move away from other harmful
behaviors, too, such as drinking alcohol or abusing other drugs
besides the problem opioid.
Just as important, treatment helps you address life issues you
might have that are tied to the addiction, such as feelings of
low self-worth, a bad situation at work or home, or spending
time with people who use drugs. In short, treatment helps you
move into a healthy, addiction-free lifestyle—into a way of living
referred to as recovery.
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Treatment may include medication.
Medication-assisted treatment is treatment for addiction
that includes the use of medication along with counseling and
other support. Treatment that includes medication is often the
best choice for opioid addiction.
If you are addicted, medication allows you to regain a normal
state of mind, free of drug-induced highs and lows. It frees you
from thinking all the time about the drug. It can reduce problems of withdrawal and craving. These changes can give you the
chance you need to focus on the lifestyle changes that lead back
to healthy living.
Taking medication for opioid addiction is like taking medication to
control heart disease or diabetes. It is NOT the same as substituting one addictive drug for another. Used properly, the medication does NOT create a new addiction. It helps you manage your
addiction so that the benefits of recovery can be maintained.
Naltrexone is a medication used to
treat opioid addiction.
Naltrexone is one of three medications commonly used to treat
opioid addiction. The other two are methadone and buprenorphine. Cost varies for the different medications. You may need to
take this into account when considering your treatment options.
Naltrexone blocks opioids from acting on the brain, so it takes
away the reward of getting high on the problem drug. This
feature makes naltrexone a good choice for preventing relapse
(falling back into problem drug use).
Naltrexone may not stop drug cravings. If it does not help with
cravings, your doctor or substance abuse treatment provider
will help you find other ways to reduce them.
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Naltrexone comes in pill form. Two trade names for it are
ReVia® and Depade®. It is also available as a lower cost generic.
You take the pill every 1 to 3 days.
Naltrexone is also available in a new extended-release form that is
injected in the buttocks. This extended-release injectable form has
the trade name Vivitrol®. The injection is administered by your
physician or other treatment provider once a month.
Naltrexone may be a good choice if you are completely past
withdrawal and highly motivated to stay in recovery. It also may
be recommended if you are in an early stage of opioid addiction.
Naltrexone may be prescribed if it is
the right choice for you.
Before you are given the first dose of any medication for opioid
addiction, your doctor will ask you questions about your addiction,
health, and other problems. You will get a drug test—usually a
check of urine or saliva. You also will have a physical exam and
tests for diseases that are common to people who have been
abusing drugs. Your liver will be checked to make sure the medication can be safely taken. If naltrexone is safe and appropriate
for you, your doctor may recommend it.
You and your doctor or substance abuse treatment provider
decide together on a treatment plan. The plan describes the
medication routine, the counseling and other services that will
be provided, and the rules that must be followed. These rules
will be explained to you, and you will get them in writing.
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Naltrexone must be used carefully.
You must have no opioids in your body before starting naltrexone. Otherwise, withdrawal will be extra strong. You first must
go through withdrawal under your doctor’s care. This supervised
withdrawal is called detoxification or detox. You can start on
naltrexone after detox is completed.
Your doctor will first prescribe a low dose. Your dose levels
may be adjusted up as needed. Always take doses exactly as
prescribed by your doctor. If you are prescribed the injectable
form of naltrexone, be sure to keep your appointments for
monthly injections.
You may take naltrexone for days, months, or years—as long
as it is needed to prevent relapse. However, you should be
checked often by your doctor if you have liver disease.
Naltrexone does not cause withdrawal when you stop taking it.
If you are stable in recovery and want to stop taking naltrexone,
you do not need to taper off over time. However, you should
always consult with your doctor before quitting naltrexone.
Some people who take naltrexone carry a medical card in case
they need emergency care. The card explains that they cannot
receive medications containing opioids and they will need
special care if they are in pain. Ask your doctor whether you
should carry a card.
Naltrexone has side effects in
some people.
Side effects are feelings of discomfort or sickness that come
with taking medicine. Naltrexone has a few mild side effects.
Usually these go away after the medicine is taken for a while.
5
If you have side effects, you should NOT stop taking the
medication. Instead, talk with your doctor or substance abuse
treatment provider. An adjustment in dosage or a change in
medication might help. There are some simple things you can
do to reduce side effects, too.
WARNINGS
• If you are taking naltrexone, you cannot get high from
other opioids because the medication blocks the effects.
Sometimes people take large amounts of opioids to try
to overcome this block. Do NOT do this! It is VERY
dangerous and can cause overdose or death.
• Naltrexone kept at home must be locked in a safe place
to prevent accidental use by others, especially children.
• If you are a woman and are pregnant or breast-feeding,
you should NOT take naltrexone. Methadone is safer for
mother and child.
• Liver problems are rare but can occur. If you have a preexisting liver condition, your doctor should conduct regular
tests on your liver.
• While taking this medication, you should NOT use other
opioid medications such as some pain medications, cough
syrups, and diarrhea medicines. The naltrexone will stop
these medications from working. You should let doctors and
dentists know you cannot have any medications (including
shots) that contain opioids.
• While taking this medication, you should NOT use illegal
drugs, drink alcohol, or take sedatives, tranquilizers, or
other drugs that slow breathing. Taking any of these
substances in large amounts along with naltrexone can
lead to overdose or death.
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COMMON SIDE EFFECTS
AND SIMPLE WAYS TO REDUCE THEM
Upset stomach or vomiting—Take the pill with food or
after a meal. Take an antacid product as directed by
your doctor.
Diarrhea—Drink plenty of water or juice. Also, ask your
doctor to recommend an over-the-counter medicine.
Headache—Use over-the-counter headache medicines
according to package instructions.
Nervousness—Take a walk, take a hot bath, or take deep
breaths. If this problem is serious or lasts a long time,
tell your doctor or substance abuse treatment provider.
Sleep problems including tiredness—Take the pill in the
morning. Avoid naps. Go to bed at the same time every
night. Exercise. Do not drink caffeine after lunchtime.
Joint or muscle pain—Use over-the-counter pain medicines
according to package instructions.
Serious side effects—For extreme stomach pain, vomiting,
or diarrhea, or if the area where you received your
injection becomes red or painful, contact your doctor
right away. Also seek help if the following side effects
appear, because they may indicate serious liver problems:
• Dark or tea-colored urine
• Bad stomachache
• Light-colored bowel movements
• Yellowing in the whites of the eyes
• Yellow skin.
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Counseling can help.
Medication is one part of treatment for opioid addiction.
For many people, another important part is counseling: the
opportunity to talk with a professional either one-on-one or in
a group with others in treatment.
Through counseling, you learn about the motivations and
behaviors that led to your opioid addiction. You learn to commit
to a more healthful lifestyle. You gain support and skills while
working with others to manage your recovery long term.
Counseling can provide encouragement and motivation to
stick to treatment. It can help you learn how to make healthy
decisions, handle setbacks and stress, and move forward with
your life.
In group counseling, you connect with others in treatment
and make new friends who don’t use drugs. You can get these
benefits from support groups, too. These are informal meetings of people facing similar challenges.
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Family and friends are important, too.
It is very hard to go through recovery alone. Support from family and friends is very important. Love and encouragement can
help you make the decision to enter treatment and stick with it.
Some treatment programs offer counseling for your loved ones.
They do this because your addiction may have caused pain and
anger or feelings of shame and hopelessness.
Counseling is a useful way for family and friends to learn more
about your situation, how to help, and how to handle the problems your addiction has caused them. It is a safe place for them
to express feelings and to find out what help is available for
everyone affected.
There are support groups for families and friends, too. These
are safe places to share information and encourage others who
have loved ones who are dealing with addiction.
Many people with opioid addiction regain normal, healthy lives.
One way they do this is with medication-assisted treatment.
Medication, counseling, and support: together they can help
you, your loved ones, and your friends.
“For me, being in recovery is about having
a job. It’s about being an active member of
my family. It’s about having friends. It’s
about having a social network. It’s about
having passion in my life again.”
Tom C.
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ADDICTION
WHAT’S TRUE AND WHAT’S NOT
Addiction is a disease. It cannot be cured, but it can
be treated with medication, counseling, and support
from family and friends. Addiction is NOT a sign of
weakness. It is NOT TRUE that all you need to kick
addiction is to “be strong.”
The Facts
The goal of medication-assisted treatment is
to recover from addiction. It does NOT replace
one addictive drug with another. It provides a safe,
controlled level of medication to overcome the use
of a problem opioid.
A substance abuse treatment provider must
obtain your informed consent (a written agreement) before sharing information about you with
others. There are two exceptions to this privacy rule:
(1) if it appears that you may harm yourself or others
and (2) if you have been ordered into treatment by the
courts. To learn more about your privacy rights, talk to
your substance abuse treatment provider.
Recovery is possible. But it takes work. After treatment is finished, everything is NOT automatically fine
again. Recovery takes commitment every day, through
treatment and beyond.
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NALTREXONE
WHAT’S TRUE AND WHAT’S NOT
Naltrexone helps you avoid relapse. It is legal
and taken under a doctor’s care. It is NOT just
another drug to abuse.
Naltrexone is produced under safe conditions
and sold legally. There is no risk of getting tainted
doses, which can happen with street drugs.
The Facts
You can stop taking naltrexone at any time
with no withdrawal or craving. It is NOT
addictive.
Few people have mood swings when taking
naltrexone. It does NOT cause depression. If you
have symptoms of depression, talk to your doctor—
there may be some other cause.
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Support groups and information
• This is not a complete list. Listing here does not mean that
the Substance Abuse and Mental Health Services Administration (SAMHSA) endorses any of the organizations.
• Some support groups have abstinence-only policies and do
not look favorably on medication-assisted treatment. The
programs listed here do not have such policies, but individual
group meetings vary. You may need to try several support
groups to find the right one.
• Some support programs are just for people with a substance
use disorder, and others allow families and friends to attend
meetings or have separate meetings for them. Check with
each organization for details.
• An Internet-based support group may be your best option
if no groups meet in your community. Another option is to
contact Alcoholics Anonymous (AA, http://www.aa.org) to
find out whether AA meetings in your community are open
to people in recovery from other substances besides alcohol.
Dual Recovery Anonymous
http://www.draonline.org or 913-991-2702
LifeRing
http://www.unhooked.com or 800-811-4142
Narcotics Anonymous
http://www.na.org or 818-773-9999
Rational Recovery
http://www.rational.org or 530-621-4374
Secular Organizations for Sobriety
http://www.cfiwest.org/sos/index.htm or 323-666-4295
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SMART Recovery
http://www.smartrecovery.org or 866-951-5357
Women for Sobriety, Inc.
http://www.womenforsobriety.org or 215-536-8026
Substance abuse treatment
facility locator
800-662-HELP (4357) (English and Español)
800-487-4889 TDD (for hearing impaired)
http://dasis3.samhsa.gov
Free booklets
• The Facts About Buprenorphine for Treatment of Opioid
Addiction (SMA) 09-4442 (also in Spanish)
• Medication-Assisted Treatment for Opioid Addiction: Facts
for Families and Friends (SMA) 09-4443 (also in Spanish)
• Introduction to Methadone (SMA) 06-4123
• Faces of Change: An Illustrated Booklet for Consumers
(SMA) 08-4174
• What Is Substance Abuse Treatment? A Booklet for Families
(SMA) 08-4126 (also in Spanish: (SMA) 08-4098)
• Motivación para el Cambio (Spanish only) PHD1133
How to get free copies
1. Ask your substance abuse treatment provider.
2. Contact SAMHSA at 877-SAMHSA-7 (877-726-4727)
(English and Español).
3. Order from http://www.store.samhsa.gov.
4. Download the products from http://www.kap.samhsa.gov.
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“You know, there’s a saying in recovery
communities about promises and promises
being true. And don’t quit until the miracle
happens. And that sounds very esoteric
and wonderful and feel-good. But it
actually is true.... Recovery and sobriety
let me show up for life today.”—
Tim S.
ACKNOWLEDGMENTS
This booklet was produced by JBS International, Inc., under Contract No. 270-04-7049
with the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental
Health Services Administration (SAMHSA), U.S. Department of Health and Human
Services (HHS).
All material appearing in this booklet is in the public domain and may be reproduced
or copied without permission from SAMHSA. Citation of the source is appreciated.
However, this publication may not be reproduced or distributed for a fee without
specific, written authorization of the Office of Communications, SAMHSA, HHS.
This publication may be downloaded or ordered at http://www.store.samhsa.gov
or call 877-SAMHSA-7 (877-726-4727) (English and Español).
HHS Publication No. (SMA) 12-4444
Printed 2009; revised 2012